Slides

Procalcitonin-Guided Antibiotic Therapy

Effects of Using Procalcitonin To Guide Antibiotic Therapy in Patients With RTIs in the Ambulatory Care or Hospital Setting (2 of 2)

There was moderate-strength evidence that procalcitonin guidance did not increase mortality, hospital length of stay, or intensive care unit (ICU) admission rates.

Overall mortality results were consistent and did not suggest higher mortality rates with procalcitonin-guided therapy when compared with the control arm. Mortality rates in patients in the control arm ranged from 0 to 13.2 percent. The absolute differences between the procalcitonin and control arms ranged from -3.6 to 1.0 percent. Six studies reported 28-day mortality; none of the differences in 28-day mortality were statistically significant.

Five studies reported hospital length of stay. Hospital length of stay was reduced with procalcitonin-guided therapy in four of five studies, with an absolute reduction in days ranging from -0.5 to -1. The differences were not statistically significant in any of the studies.

Five studies reported the need for ICU admission. ICU admission rates were reduced with procalcitonin-guided therapy with absolute reductions ranging from -0.7 to -2.5 percent. None of the reductions in ICU admissions was statistically significant.

Three studies reported on antibiotic adverse effects; however, the data were inconsistent and imprecise. Two studies reported percentages with absolute differences of -8.2 percent and 2.8 percent, and one study reported an absolute difference of -1.1 days that was statistically significant. The data for this outcome were limited and did not permit conclusions about the impact of procalcitonin-guided therapy on antibiotic-associated adverse events; the strength of evidence for this finding was rated insufficient.